Pneumonia and influenza are the sixth leading cause of death in the United States. The pneumococcal immunization rate for adults with high risk conditions who are under 65 years of age is extremely low, generally estimated to be less than 20%. Various types of interventions used to increase vaccination coverage have been investigated among traditional vaccine administrators. So far, little attention has been given to the potential impact of pharmacy-based vaccination services. The primary goal of this study is to design, implement, and evaluate a pro-active vaccination service that significantly increases pneumococcal vaccination coverage and that is: simple to implement, acceptable to providers and clients, applicable to diverse pharmacy practice environments, sustainable and sustained. A multi-component intervention, as recommended by the Task Force on Community Preventive Services, is used in order to optimize vaccination coverage. A quasi-experimental design of a multi-component intervention that targets community pharmacies and their patients in matched intervention and control counties in Alabama; Tennessee, and Wisconsin. The intervention includes system-, provider- and patient/community-oriented strategies for increasing Pneumococcal vaccination coverage. Four key outcomes to be examined are the intervention effects (Hypothesis 1), intervention process (Hypothesis 2),.rates of participation (Hypothesis 3), and institutionalization (Hypothesis 4). Data will be gathered both at the pharmacy-level, using a telephone- survey format and at the staff-level, using a web-based survey format. Repeat measures will be used to assess the perceptions of vaccination services before, during, and after the interventions. This proposed study will make several contributions. First, it will investigate the intervention effects in community pharmacy settings that previously have not been done. Second, it addresses several knowledge gaps in intervention studies including intervention fidelity, the differences between participating and nonparticipating sites, and lastly the sustainability of pharmacy-based vaccination services beyond the intervention period. Increased understanding of factors influencing these key outcomes will help policy-makers and healthcare practitioners plan to facilitate the diffusion of this important practice. [unreadable] [unreadable] [unreadable]